Cedar Grove Baptist Sports Organization

Cedar Grove Baptist Sports Organization

Application Form: Volunteer/Volunteer Coach

Release Authorization for Volunteer Service

Confidential

Name ______

Our programs and leagues would not be possible without people who generously volunteer their time. Thank you for your commitment to work with us to make CGBC leagues a place where children can develop both athletically and spiritually.

Your CGBC staff

CedarGroveBaptistChurch Sports Organization

Application Form: Volunteer Coach

Release Authorization for Volunteer Service

Confidential

This application is to be completed by all applicants for any position involving the supervision or custody of minors. It is being used to help CGBC provide a safe and secure environment for those children and youth who participate in our programs and use our facilities. PLEASE PRINT CLEARLY. Questions in bold are required to perform a background check.

Volunteer Application for CedarGroveBaptistChurch

This application is to be completed by all persons who desire to work on a regular basis with children or youth in our church’s ministries. This application form is being used to help the church provide a safe and secure environment for the protection of the church and all the children and youth under the care of the church.

PLEASE PRINT

FIRST NAME ______MIDDLE NAME ______LAST NAME ______

SEX ______RACE ______DATE OF BIRTH ______MAIDEN NAME ______

SOCIAL SECURITY NO. ______

ADDRESS______

CITY______STATE______

ZIP______HOW LONG AT PRESENT ADDRESS? ______

HOME PHONE______

PREVIOUS ADDRESS (IF AT PRESENT ADDRESSES LESS THAN 2 YEARS)

______

I AM ( ) ADULT OCCUPATION______PRESENT EMPLOYER ______

( ) STUDENT AGE ______CURRENT GRADE ______SCHOOL______

NAME OF CHURCH OF WHICH YOU ARE A MEMBER OR ATTENDING: ______

HOW LONG? ______IF LESS THAN 1 YEAR, LIST THE NAME AND ADDRESS OF THE PREVIOUS CHURCH YOU REGULARLY ATTENDED: ______

EMERGENCY CONTACT NAME ______PHONE ______

VOLUNTEER POSITION DESIRED: ______

HAVE YOU EVER BEEN CONVICTED OF OR PLEADED GUILTY TO A CRIME? IF YES PLEASE EXPLAIN;

______

______

DO YOU HAVE A VALID DRIVER’S LICENSE? _____YES _____NO

DRIVER’S LICENSE # ______

DO YOU HAVE DRIVER’S LIABILITY INSURANCE? _____YES _____NO

CARRIER NAME ______

HAVE YOU HAD A TRAFFIC VIOLATION WITHIN THE PAST 5 YEARS? IF YES, SPECIFY FOR WHAT AND THE DATE(S) OF THE TICKET(S). ______

CEDARGRVEBAPTISTCHURCHRESERVES THE RIGHT TO DENY VOLUNTEER OPPORTUNITIES TO ANYONE IN ITS SOLE DISCRETION. BY SIGNING THIS FORM, I AM AFFIRMING THAT THE ABOVE STATEMENTS I HAVE MADE ARE TRUE AND FACTUAL TO THE BEST OF MY KNOWLEDGE. I AM GRANTING PERMISSION FOR ALL PERSONS, ORGANIZATIONS, OR AGENCIES, STATE LAW ENFORCEMENT FOR CRIMINAL RECORDS.

______

DATE APPLICANT’S SIGNATURE PARENT’S SIGNATURE IF UNDER 18

Applicant’s Statement

The information contained in the application is correct to the best of my knowledge. I authorize any reference or church listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for work with children and/or youth. In consideration of the receipt and evaluation of this application by the Cedar Grove Baptist Church Sports Organization located 1289 Cedar Road, Stamping Ground, KY 40379 (referred to herein asGCBC); I hereby release any individual, church, youth organization, charity, employer, reference or any other person or organization, including recognized custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or my family, on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

This authorization and consent for release of personal information acknowledges that CedarGroveBaptistChurch may now or at any time I am either employed by the church or in a volunteer service, conduct investigations whether the records are of a public, private, or confidential nature. These investigations might include, but are not limited to, personal reference, name verification, social security verification, county civil court records, sex offender registries, child abuse, county felony criminal history, countymisdemeanor or criminal history, federal civil court records and criminal history (statewide, federal or extended).

I understand that these searches will be used to determine volunteer work assignmentforCedarGroveBaptistChurch. Therefore, I authorize and consent for full release of records to the authorized representatives of the church. In addition, I release and discharge Cedar Grove Baptist Church and its agents and associates to the full extent permitted by law from any claims, damages, losses, liabilities, expenses or any other charges or complaints filed with any agency arising from retrieving and reporting this information. I understand that according to the FederalFair Credit Act, I am entitled to know whether volunteer service was denied based upon the information obtained and to receive, upon written request, a disclosure of the background report.

Should my application be accepted, I agree to be bound by the bylaws and policies of CGBC and to refrain from poor conduct (as defined in the Coaches’ Handbook) in the performance of my services on behalf of CGBC.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENT THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. I fully understand its content and authorize the background verification. This is a legally binding agreement, which I have read and understood.

Print Signature: ______

Signature: ______Date: ______

CGBC use only

Authorized signature: ______Date: ______